DISULFIRAM
Drugs in Pregnancy and Lactation.
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Name: DISULFIRAM
Class: Miscellaneous
Risk Factor: C
Fetal Risk Summary
Disulfiram is used to prevent alcohol consumption in patients with a history of alcohol abuse. In animals, disulfiram is embryotoxic, possibly due to copper chelation, but it is not teratogenic (1).
No reports describing the placental transfer of disulfiram have been located. The molecular weight (about 297) is low enough that transfer to the fetus probably occurs.
Published reports describing the use of disulfiram in gestation involve 36 pregnancies (2,3,4,5,6,7,8 and 9). Eleven of the 38 exposed fetuses (two sets of twins) had congenital defects, 6 pregnancies were terminated electively, a spontaneous abortion occurred in 1 case, 1 was stillborn, 5 were lost to follow-up, and 14 newborns were normal. No congenital malformations were observed in autopsies conducted on three of the elective terminations (4). The malformations observed, some of which were or may have been related to alcohol exposure or other causes, were:
Clubfoot (two cases) (2)
Multiple anomalies with VACTERL syndrome (radial aplasia, vertebral fusion, tracheo esophageal fistula) (twin) (3)
Phocomelia of lower extremities (one case) (3)
Microcephaly, mental retardation (possible fetal alcohol syndrome) (one case) (5)
Pierre-Robin sequence, pulmonary atresia (one case) (6)
Cleft soft palate, short palpebral fissure (twin) (8)
Limb reduction right forearm (radius and ulna), 2 rudimentary fingers without nails, short palpebral fissure (twin) (8)
Fetal Alcohol Syndrome (two cases; both mothers continued to drink) (9)
Fetal Hydantoin Syndrome (mother also took phenytoin) (one case) (9)
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 25 newborns had been exposed to disulfiram during the 1st trimester (F. Rosa, personal communication, FDA, 1993). One (4.0%) major birth defect was observed (one expected), a cardiovascular defect.
In summary, the lack of teratogenicity in animals and the absence of a clustering of similar birth defects in human pregnancies exposed to disulfiram suggests that this drug is not a major human teratogen. Obviously, women taking disulfiram should not drink alcohol, but this is occasionally the case because of the findings of fetal alcohol syndrome and defects that are suggestive of fetal alcohol exposure.
Breast Feeding Summary
No reports describing the use of disulfiram during lactation have been located. Because of the relatively low molecular weight (about 297), excretion into milk should be expected. The potential effects of this exposure on a nursing infant are unknown.
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References
- Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD:Johns Hopkins University Press, 1989:239–40.
- Favre-Tissot M, Delatour P. Psychopharmacologie et teratogenese a propos du sulfirame: essal experimental. Annales Medico-psychogiques 1965;1:735–40. As cited in Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD:Johns Hopkins University Press, 1989:239–40.
- Nora AH, Nora JJ, Blu J. Limb-reduction anomalies in infants born to disulfiram-treated alcoholic mothers Lancet 1977;2:664.
- Hamon B, Soyez C, Jonville AP, Autret E. Grossesse chez les malades traitées par le disulfirame. Press Med 1991;20:1092.
- Gardner RJM, Clarkson JE. A malformed child whose previously alcoholic mother had taken disultiram. NZ Med J 1981;93:184–6. As cited in Reitnauer PJ, Callanan NP, Farber RA, Aylsworth AS. Prenatal exposure to disulfiram implicated in the cause of malformations in discordant monozygotic twins. Teratology 1997;56:358–62.
- Dehaene P, Titran M, Dubois D. Syndrome de Pierre Robin et malformations cardiaques chez un nouveau-ne. Presse Med 1984;13:1394–5. As cited in Reitnauer PJ, Callanan NP, Farber RA, Aylsworth AS. Prenatal exposure to disulfiram implicated in the cause of malformations in discordant monozygotic twins. Teratology 1997;56:358–62.
- Helmbrecht GD, Hoskins IA. First trimester disulfiram exposure: report of two cases. Am J Perinatol 1993;10:5–7.
- Reitnauer PJ, Callanan NP, Farber RA, Aylsworth AS. Prenatal exposure to disulfiram implicated in the cause of malformations in discordant monozygotic twins. Teratology 1997;56:358–62.
- Johnson KA, Jones KL, Chambers CC, Hames C, Emery M. The effect of disulfiram on the unborn baby (abstract). Teratology 1991;43:438.
Q&A about Disulfiram
14 days have gone after disulfiram intake. is it now safe to consume alcohol without suffering any side effects?
I am contemplating going on a course of this medication that makes the user get completely sick after ingesting any alcoholic drinks, in order to force myself to stop drinking. I would really like to know about anyones experiences with this medication.
the drug disulfiram used in treatment of alcoholism..why does it leave the patient feeling ill when they take it?
Most times the milder side effects will diminish with time as the body gets use to the medication, If it does not, or if the side effects are bad, the doctor needs to be consulted.
Disulfiram produces an acute sensitivity to alcohol and so the patient must make sure they do not have alcohol in their system. Besides beverage alcohol, including those so called non-alcoholic beer type beverages which contain a small amount, regardless of the label. There are also other sources of alcohol in such products as some cough medicines, perfumes, etc. You need to avoid any and all products with alcohol from being ingested, inhaled, or absorbed through the skin.
If you continue to experience side effects from using Disulfiram consult your doctor.
or something to help someone stop drinking
Go to your doctor. There are a million online Canadian pharmacies. I am sure you can get it there too, although I don't recommend it.
Be sure you read all the information on the drug.
I've finished a 10 month treatment on Citalopram and feel much better. I'm getting sorting out bit by bit! Next is the alcohol abuse. My doctor said yesterday that if I stay sober this week (woooo) I can start Disulfiram treatment on Friday. I think this will work for me. I've arranged counselling and started replacing mouth wash etc with alcohol free. I know about the obvious foods to avoid but does anyone know of any hidden alcohol in food stuffs. I understand vinegar is to be avoided. Is that right? Any alcohol in products like air freshner? Any body know? Any body been on the treament? Any help would be seriously appreciated. It's going to be very difficult and I want to be as prepared as possible.
I was on Antabuse(Disulfiram) in the eighty's ,it worked for me, I do not touch any alcohol now, I now class myself as an alcoholic, because I know what would happen if I had any alcohol, You have to very careful when taking this drug,you must not eat/ drink anything that has alcohol in it, What I did was to cook plain food, meat, fish & veg,and if I did buy ready made food I would read all the labels, at the time I lived in London and had a very good Doctor and I went to a clinic that was held in a probation office, I wasn't on probation/or in any trouble it just happened to be where the clinic was held, the Probation Officer was a great help as well, he help us with the food issue, I never had the drug myself the probation officer used to administer it to me everyday, the only day I had the drug was on a Sunday because they were closed I took the drug 7 days a week and I had to sign a book everytime I had took drug,and then he looked in my mouth to check I'd swallowed it, it's not like that these days,I was very lucky to have had the chance to be on the programme.
You could try sainsbury's they have allergy lists maybe they have one for this alcohol free, also you need to know what the E numbers contain again ask sainsburys/doctor,cough mixture is a no no, Please be very careful if you do get to take Antabuse, this is brilliant drug, but if you do touch any alcohol, it makes you very ill and I mean ill, I do hope you get Antabuse, if you persevere everything will turn out allright for you,Please don't read the Disulfiram site it will frighten you it is from Canada. when I said it makes you ill ,it does you go red,sick,shake, get hot, it feels like a heart attack, it is horrid, it lasts for a couple of hours, and you cannot take another tablet for over 12 hours, Are you doing this for yourself, to make yourself better, or are you being pushed into it,this drug has to be explained to you and all the pro's and con's about it, make an appointment to see your Doctor A.S.A.P. this is serious, You cannot eat out because lots of food is cooked in wine, Please think about eveything before taking this drug
its a type of pill
...you certainly wouldn't want to drink any alcohol while on disulfiram, though...of course!
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Hope this helps!
